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Non-Hepatic Abdominal Surgery in Patients with Cirrhotic Liver Disease

Laura Hickman1, Lauren Tanner2, John Christein1

  • 1Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|November 23, 2018
PubMed

Insights

Cirrhotic liver disease increases surgical risks. Patients with mild liver dysfunction (MELD <12 or Child A) can safely undergo elective surgery with proper education, while severe cases (MELD >20 or Child C) require transplantation first.

Area of Science:

  • Hepatology
  • Surgical Gastroenterology
  • Critical Care Medicine

Background:

  • Cirrhotic liver disease significantly impacts peri-operative outcomes in general surgery.
  • Liver dysfunction requires careful assessment and management before elective surgical procedures.

Purpose of the Study:

  • To evaluate the peri-operative risks associated with cirrhotic liver disease.
  • To provide guidance on surgical management strategies for patients with varying degrees of liver dysfunction.

Main Methods:

  • Review of peri-operative morbidity and mortality in general surgical patients with cirrhotic liver disease.
  • Stratification of surgical risk based on MELD scores and Child-Pugh classification.

Main Results:

  • Patients with MELD <12 or Child A cirrhosis have increased risks but are generally safe for elective surgery with patient education.
  • Patients with MELD >20 or Child C cirrhosis face over 40% mortality, necessitating transplantation before elective procedures.
  • Laparoscopic surgery is a feasible and safe option for cirrhotic patients.

Conclusions:

  • Early recognition and optimization of liver dysfunction are crucial for surgical patients.
  • Risk stratification using MELD and Child-Pugh classifications guides peri-operative decision-making in cirrhosis.
  • Appropriate management, including transplantation and surgical approach selection, can improve outcomes for cirrhotic patients undergoing surgery.

Keywords:
Abdominal surgeryAppropriate surgical decision makingChronic liver diseaseCirrhosisPostoperative care

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